Wahdan AS, Moussa AA, Farag MAF
… +2 more, Alayyaf HA, Mohamed MM
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248777
·
Full text
BACKGROUND AND AIMS: Providing postoperative pain management in patients who underwent scrotal surgeries is achieved using several methods, one of which is the ultrasound-guided spermatic cord block (US-SCB). To enhance...BACKGROUND AND AIMS: Providing postoperative pain management in patients who underwent scrotal surgeries is achieved using several methods, one of which is the ultrasound-guided spermatic cord block (US-SCB). To enhance anesthesia quality and extend analgesia postoperatively, several agents have been added in conjunction with local agents. This study targeted assessing the results of combining neostigmine with levobupivacaine in US-SCB for providing perioperative analgesia in patients undergoing testicular sperm extraction (TESE) surgery. MATERIAL AND METHODS: This double-blind, randomized controlled study was performed for 112 subjects undergoing TESE operation using general anesthesia. They were randomly and equally divided into two groups. All participants received bilateral US-SCB after induction of general anesthesia by 19 mL of levobupivacaine 0.5% combined with 1 mL of neostigmine 500 μg in (group N) or 1 mL of normal saline in (group C). The first analgesic dose request time and the amount of analgesic consumed in the first 24 h were the main points of comparison in both groups. RESULTS: The mean postoperative analgesia duration was noticeably increased in the N group compared to the C group, with a value of 480 ± 41.34 min versus 404 ± 34.14 min, independently ( < 0.001). Moreover, the total amount of postoperative analgesic consumption was remarkably decreased in group N when compared to group C without statistically remarkable divergence concerning complications between both groups. CONCLUSION: Adding neostigmine to a local anesthetic solution in US-SCB proved to detain the first analgesic request postoperatively with reduced perioperative analgesia consumption, without significant side effects.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248775
·
Full text
INTRODUCTION: Weaning of patient from ventilator and finally extubation is a challenge, especially in critical care setup. Though many parameters are available, based on which, the decision of extubation is taken but sti...INTRODUCTION: Weaning of patient from ventilator and finally extubation is a challenge, especially in critical care setup. Though many parameters are available, based on which, the decision of extubation is taken but still many times, there is failure of weaning. AIM: We conducted a prospective observational study to look for diaphragm and abdominal muscle thickness, contraction, and lung ultrasound as indicator for weaning and extubation. MATERIAL AND METHODS: Patients of either gender aged between 20-50 years, who were on invasive mechanical ventilation for more than 48 hrs. and put on spontaneous breathing trial. A bedside ultrasound examination was performed. Abdominal expiratory muscle thickness, diaphragmatic excursion (DE), diaphragmatic thickness fraction (DTF) and lung ultrasound score (LUS) were measured. RESULTS: 12 patients had simple weaning pattern whereas 5 patients had difficult weaning and 8 patients had prolonged weaning. The mean value of DE was 1.97 cm, DTF- 2.3 mm. The mean value of SOFA score is significant between simple, difficult, prolonged weaning (2.24, 4.56, 7.33 respectively). The DE, which is 2.52, 1.26, 1.81 in simple difficult and prolonged weaning respectively is highly significant. The mean value of LUS was 8.34 and is significant in all weaning patterns. The highest sensitivity is found for SOFA score (84.62) with AUC of 0.88. CONCLUSION: Evaluation of patient with diaphragm thickness fraction (mean DTF of 26%) and diaphragm excursion (2.52 cm) with mean LUS score of 4.67 opens a new dimension to predict weaning in critically ill patients who are put on spontaneous breathing trial. The sequence of thickness of abdominal expiratory muscles adds to accuracy in successful weaning. Larger muti-center trials are required to make these parameters as a standard practice for weaning patients in critical care setup.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40248774
·
Full text
BACKGROUND AND AIMS: The field of anaesthesiology and perioperative medicine has explored advancements in science and technology, ensuring precision and personalized anesthesia plans. The surge in the usage of chat-gener...BACKGROUND AND AIMS: The field of anaesthesiology and perioperative medicine has explored advancements in science and technology, ensuring precision and personalized anesthesia plans. The surge in the usage of chat-generative pretrained transformer (Chat GPT) in medicine has evoked interest among anesthesiologists to assess its performance in the operating room. However, there is concern about accuracy, patient privacy and ethics. Our objective in this study assess whether Chat GPT can provide assistance in clinical decisions and compare them with those of resident anesthesiologists. MATERIAL AND METHODS: In this cross-sectional study conducted at a teaching hospital, a set of 30 hypothetical clinical scenarios in the operating room were presented to resident anesthesiologists and Chat-GPT 4. The first five scenarios out of 30 were typed with three additional prompts in the same chat to determine if there was any detailing of answers. The responses were labeled and assessed by three reviewers not involved in the study. RESULTS: The interclass coefficient (ICC) values show variation in the level of agreement between Chat GPT and anesthesiologists. For instance, the ICC of 0.41 between A1 and Chat GPT indicates a moderate level of agreement, whereas the ICC of 0.06 between A2 and Chat GPT suggests a comparatively weaker level of agreement. CONCLUSIONS: In this study, it was found that there were variations in the level of agreement between Chat GPT and resident anesthesiologists' response in terms of accuracy and comprehensiveness of responses in solving intraoperative scenarios. The use of prompts improved the agreement of Chat GPT with anesthesiologists.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40026752
·
Full text
BACKGROUND AND AIMS: Major head neck surgeries are often associated with major blood loss requiring blood transfusion. However, in spite of transfusion, patients usually suffer adverse postoperative outcomes. Biomarkers...BACKGROUND AND AIMS: Major head neck surgeries are often associated with major blood loss requiring blood transfusion. However, in spite of transfusion, patients usually suffer adverse postoperative outcomes. Biomarkers can help in identifying such events early. This observational study was conducted to compare blood lactate and bicarbonate levels as predictors of adverse postoperative outcomes. MATERIALS AND METHODS: Forty-eight adult American Society of Anesthesiologists Physical Status I-III patients met the inclusion criteria. Intraoperative blood loss was managed with stored blood transfusion as per transfusion trigger. Blood lactate and bicarbonate levels were measured preoperatively (Tbas), at the immediate postoperative period (T0), and at 8 h (T8), 16 h (T16), and 24 h (T24) postoperatively. Outcomes such as need for intensive care unit (ICU) admission, length of ICU stay, intraoperative blood transfusion, re-exploration rate, and mortality were recorded. RESULTS: Blood transfusions and ICU admissions were required in 19 (39.6%) and 24 (50%) patients, respectively. Lactate levels of patients requiring blood transfusion and admission to ICU rose significantly from their baseline (1.30 ± 0.41 mmol/l) to 2.80 ± 1.14 mmol/l at the immediate postoperative period, which fell to 2.06 ± 0.78 mmol/l at 24 h postoperatively, compared to other patients who did not require transfusion and ICU admission ( < 0.001). The bicarbonate value did not show any significant change from its baseline (22.68 ± 1.83 mEq/l) at all time points ( = 0.8). In addition, no significant difference was noted regarding ICU admissions ( = 0.659) or blood transfusions ( = 0.788). CONCLUSIONS: Following major head and neck surgeries, blood lactate level is a good predictor, but bicarbonate is a poor predictor of the need for blood transfusions and ICU admission. Intraoperative blood transfusion failed to prevent rise in blood lactate level, which is taken as a surrogate marker of tissue hypoxia.
Jain D, Gandhi K, Gupta M
… +2 more, Jain K, Bhukal I
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40026751
·
Full text
There is a lack of consensus and uniformity about the test dose in epidurals for labor analgesia. We, therefore, conducted a questionnaire-based survey to assess the current practice in India regarding test-dose for labo...There is a lack of consensus and uniformity about the test dose in epidurals for labor analgesia. We, therefore, conducted a questionnaire-based survey to assess the current practice in India regarding test-dose for labor epidurals among practicing obstetric anesthetists. A Google form based questionnaire was circulated to 300 members of the Association of Obstetric Anesthesiologists (AOA) of India of which 128 (42.7%) responded. According to our survey, labor analgesia is routinely practiced by only 40 (32%) responders. Sixty-eight (53.1%) responders reported placement of an epidural catheter at the patient's request. Less than 50% reported the use of test dose for epidural catheter placement confirmation. Ninety-eight (76.6%) responders give the test dose at the time of catheter placement while 22 (17.1%) give it every time before injecting the local anesthetic as a top-up. The majority preferred using 3-4 mL of 2% lidocaine as test dose. Seventy-three (57%) responders relied on the use of conventional test dose of lidocaine with epinephrine. 8.5% of responders had experienced side effects with epidural test dose during labor analgesia. This survey highlights not just variations in the clinical practice regarding epidural test dose for labor analgesia but gross deviation from the current recommended standard of practice. The issue can be addressed by developing clear practice guidelines.
Deshpande SS, Kurdi M, Baiju A
… +3 more, Athira AS, Sarasamma AG, Gangadharan AK
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40026748
·
Full text
BACKGROUND AND AIMS: Preoperational anxiety affects the outcome of anesthesia and surgery. Benzodiazepines impair psychomotor performance and cause excessive sedation. L-theanine is a unique amino acid found in green tea...BACKGROUND AND AIMS: Preoperational anxiety affects the outcome of anesthesia and surgery. Benzodiazepines impair psychomotor performance and cause excessive sedation. L-theanine is a unique amino acid found in green tea. It prevents stress, produces anxiolysis, modulates alpha activity, and provides beneficial effects on mental state, including sleep quality. Gamma-aminobutyric acid (GABA) is a non-proteinogenic amino acid and a phytochemical that is the main inhibitory neurotransmitter in the mammalian brain. It is beneficial in anxiety and stress regulation. Hence, alternative premedicants such as L-theanine and GABA will have a widespread appeal and are safer. The primary objective was to study and compare the effects of L-theanine and GABA on preoperative anxiety, sedation, and cognition in patients posted for major elective surgeries. The secondary objective was to study adverse reactions. MATERIAL AND METHODS: A total of 168 patients aged between 18 and 55 years, belonging to the American Society of Anesthesiologists physical status class I and II, and satisfying all inclusion criteria were randomly divided into three groups that received either oral L-theanine, oral GABA, or oral alprazolam 0.25 mg. The anxiety score, sedation score, and psychomotor and cognitive performance scores were noted 60 minutes before and after the administration of the drugs. RESULTS: Alprazolam produced more sedation than GABA and L-theanine ( = 0.0001). Psychomotor and cognitive functions improved with L-theanine and GABA ( = 0.0001) and decreased with alprazolam ( = 0.0001). CONCLUSION: GABA and L-theanine result in effective preoperative anxiolysis with minimal sedation and improvement of cognitive skills.
Bansal S, Giribabu P, Sriganesh K
… +1 more, Shukla D
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40026747
·
Full text
BACKGROUND AND AIMS: The long-term effects of coronavirus disease 2019 (COVID-19) infection (long-COVID) are being increasingly recognized. The long-COVID effects are more likely in individuals who were symptomatic than...BACKGROUND AND AIMS: The long-term effects of coronavirus disease 2019 (COVID-19) infection (long-COVID) are being increasingly recognized. The long-COVID effects are more likely in individuals who were symptomatic than asymptomatic during their previous COVID-19 infection. The data on perioperative outcomes of patients undergoing elective neurosurgery long after their recovery from COVID-19 infection is lacking. The primary objective of this study was to compare the perioperative outcomes after elective neurosurgery between patients who were symptomatic and those who were asymptomatic during their previous COVID-19 infection. The secondary objectives were to compare the earlier COVID-19 characteristics and the perioperative pulmonary profile during current surgery between these groups. MATERIAL AND METHODS: This prospective observational study was performed in adult patients undergoing elective neurosurgery with history of previous COVID-19 infection. Data was collected regarding previous COVID-19 infection (symptoms, hospitalization, treatment, complications, etc.) and current perioperative characteristics (pulmonary profile, perioperative complications, hospital stay, mortality, etc.). RESULTS: A total of 50 patients were recruited during the study period, of which 35 (73%) patients were symptomatic during previous COVID-19 infection (two patients were excluded). The mean duration between current surgery and previous COVID-19 infection was 7 months. Patients symptomatic during earlier COVID-19 infection were females, older, and had a lower oxygen level during current surgery. There was no difference between symptomatic and asymptomatic groups in adverse perioperative outcomes such as desaturation, pulmonary or extrapulmonary complications, or non-extubation. CONCLUSION: The perioperative outcomes of patients undergoing elective neurosurgery with previous mild to moderate symptomatic COVID-19 infection may not be different from those of patients with asymptomatic COVID-19 infection.
Ganigara A, Bhavana DA, Chandrika YR
… +1 more, Sharma T
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40026746
·
Full text
BACKGROUND AND AIMS: Tracheal extubation after general anaesthesia in pediatrics is a critical event, with sparse research on positioning of patient during extubation. Clinical data reveal lesser airway obstruction in th...BACKGROUND AND AIMS: Tracheal extubation after general anaesthesia in pediatrics is a critical event, with sparse research on positioning of patient during extubation. Clinical data reveal lesser airway obstruction in the lateral position with enhanced airway patency. We studied the effects of supine versus lateral positioning on the quality of tracheal extubation as judged by the modified Minogue cough score in children undergoing elective surgeries under general anaesthesia. Secondary objectives included frequency of incidences of oxygen desaturation (SPO2 <92%), laryngospasm, bronchospasm, and stridor. MATERIAL AND METHODS: In this single-blinded randomised trial, 110 children in the age group of 2-12 years were enrolled to be positioned in either the lateral (group L) or supine (group S) position during extubation at the end of surgery. All patients received a standardised anaesthesia regimen. Chin lift and positive pressure ventilation were instituted if airway patency was noted to be compromised during extubation. Vital parameters, extubation quality, sedation score, incidence of oxygen desaturation, laryngospasm, stridor, and bronchospasm were recorded every 5 minutes till 30 minutes post extubation. RESULTS: Children in group S were noted to have a higher cough score at the 15 minute post extubation with a value of 0.04 compared to children in group L. Children in group L had a 18% incidence of adverse respiratory events compared to 30% in group S with a relative risk of 1.67. CONCLUSIONS: Positioning children in the lateral position during extubation resulted in improved extubation quality as evidenced by lower cough scores with fewer incidence of complications in comparison to supine position extubation.
Rastogi A, Singh AK, Srivastava D
… +3 more, Kannaujia AK, Singh TK, Mishra P
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40026745
·
Full text
BACKGROUND AND AIMS: The contemporary literature review suggests upper airway ultrasound can help us to diagnose an unanticipated difficult airway before laryngoscopy. The primary objective of this study was to compare u...BACKGROUND AND AIMS: The contemporary literature review suggests upper airway ultrasound can help us to diagnose an unanticipated difficult airway before laryngoscopy. The primary objective of this study was to compare ultrasonography (USG) and clinical airway indices across easy and difficult laryngoscopy groups. MATERIAL AND METHODS: This prospective observational study included 258 patients scheduled to undergo surgery under general anesthesia with endotracheal intubation. Ultrasonographic upper airway parameters, viz., tongue thickness (TT), skin-to-epiglottis distance (DSE), and tongue thickness to thyromental distance ratio (TT/TMD) were measured. Patients were identified as easy or difficult laryngoscopy groups based on their Cormack Lehane (CL) grading. RESULTS: Out of 258 patients, 20 (7.75%) had difficult laryngoscopy, and 238 (92%) had easy laryngoscopy. The USG measured TT mean, and median values were 6.16 ± 0.39 [6.10] cm in difficult and 5.41 ± 0.36 [5.40] cm in easy laryngoscopy groups. The USG measured mean and median value of DSE were 2.75 ± 0.09 [2.74] in difficult and 2.27 ± 0.23 [2.27] in easy laryngoscopy groups. The ratio of TT/TMD with mean and median values of 0.98 ± 0.07 [0.99] in difficult and 0.84 ± 0.13 [0.82] in easy laryngoscopy. Using the inputs, the diagnostic accuracy of the ultrasound-measured significant variables was calculated in terms of their area under the curve using the receiver operating characteristic curve. CONCLUSIONS: This study revealed a relationship between sonographic measurements like TT, DSE, and TT/TMD ratio for easy and difficult laryngoscopy identification. Including these sonographic parameters and their cut-off values may enhance our ability to predict an unanticipated difficult laryngoscopy.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40026744
·
Full text
BACKGROUND AND AIMS: Raised intracranial pressure (ICP) is believed to be one of the side effects of prolonged Trendelenburg position in robotic gynecologic surgeries. Optic nerve sheath diameter (ONSD) corresponds to a...BACKGROUND AND AIMS: Raised intracranial pressure (ICP) is believed to be one of the side effects of prolonged Trendelenburg position in robotic gynecologic surgeries. Optic nerve sheath diameter (ONSD) corresponds to a rise in ICP. However, the data from robotic hysterectomy surgeries is limited. So, we had planned this study with an aim to detect and compare the change in ONSD during prolonged steep Trendelenburg position in robotic hysterectomy compared to open total abdominal hysterectomy in a supine position. MATERIAL AND METHODS: This was a prospective, observational, parallel-group, single-center study. Patients undergoing elective robotic hysterectomy and open total abdominal hysterectomy were included in this study. ONSD, end-tidal carbon dioxide (EtCO), heart rate, and mean arterial pressure were assessed in both the groups after intubation (T0), after steep Trendelenburg position (T1), at 30 min (T2), 90 min (T3), and 180 min after docking (T4), and at the completion of surgery (de-docking) (T5). In patients undergoing open hysterectomy, the same parameters were recorded immediately after intubation (T0), at skin incision (T1), at 30 min (T2), 90 min (T3), and 180 min after skin incision (T4), and at the completion of surgery (T5). RESULTS: Compared to the patients undergoing open hysterectomy, robotic hysterectomy patients had a significantly higher ONSD at time points T2, T3, and T4, with the maximum difference noted at the time point T4. EtCO was higher in patients undergoing robotic hysterectomy, though the difference was significant only at time point T2. No patient in our study had any symptom or sign of raised ICP in the postoperative period. CONCLUSION: The steep Trendelenburg position used in robotic hysterectomy causes a significant increase in ONSD intraoperatively, and that the changes are reversible after the procedure. Further, we did not observe any complication of raised ICP postoperatively.
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40026743
·
Full text
The care of transgender individuals has gained increasing attention in health-care settings, encompassing a wide range of medical specialties. Anesthesia is vital in perioperative care for them despite challenges like he...The care of transgender individuals has gained increasing attention in health-care settings, encompassing a wide range of medical specialties. Anesthesia is vital in perioperative care for them despite challenges like health-care access disparities, stigma, and discrimination. As they undergo routine surgeries or specific gender-affirming surgeries, anesthesia providers must be cognizant of anatomical, physiological, and psychosocial considerations that may impact the perioperative experience. Anesthesia for transgender individuals requires gender identity assessment, understanding of surgical needs, hormone therapy impact, preoperative assessments evaluating comorbidities, medication history, and psychosocial factors. Anesthesiologists should modify airway care and pain management techniques to accommodate patients' preferences and gender-affirming surgical goals. They should also take into account any potential differences in the airways of transgender patients and optimize postoperative pain management in accordance with each patient's particular surgical recovery. This article aims to focus on the perioperative care of transgender individuals, highlighting the distinct challenges encountered and potential solutions to address these unique issues.
Kumari K, Jain N, Rathod DK
… +6 more, Syal R, Meshram T, Sharma A, Kaur M, Singh M, Bhatia P
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40026741
·
Full text
BACKGROUND AND AIMS: Analgesic efficacy and safety of continuous catheter technique in transmuscular quadratus lumborum block (QLB3) for laparoscopic nephrectomy has not been studied. This study was planned to evaluate t...BACKGROUND AND AIMS: Analgesic efficacy and safety of continuous catheter technique in transmuscular quadratus lumborum block (QLB3) for laparoscopic nephrectomy has not been studied. This study was planned to evaluate the efficacy and safety of ultrasound (US)-guided continuous QLB3 for postoperative analgesia after laparoscopic nephrectomy. MATERIAL AND METHODS: In this randomized, open-label, single-centered trial, 64 patients belonging to the American Society of Anesthesiologists, physical status grade I and II, 18-65 years of age, scheduled for laparoscopic nephrectomy were included. Patients were randomized into the QLB group and the control group. After surgery, the QLB group received transmuscular QLB with a 0.4 mL/kg bolus of 0.25% ropivacaine and catheter insertion for continuous infusion of 0.25% ropivacaine at 0.1 mL/kg/h. Patients in both groups received fentanyl (0.5 μg/kg) as rescue analgesia by IV PCA pump. RESULTS: The data of 30 patients in each group were analyzed. Total fentanyl consumption during the first 48 h postoperatively was significantly lower in the QLB group compared to the control group (mean ± SD; QLB group = 74.33 ± 32.75 μg; control group = 209.10 ± 52.04 μg) ( < 0.001). Postoperative NRS pain scores at rest and on movement were significantly lower in the QLB group compared to the control group at various time intervals up to 48 h postoperative ( < 0.05). No severe complications were seen in any of the patients. CONCLUSIONS: US-guided continuous catheter transmuscular QLB reduced postoperative opioid consumption by 64.45% and decreased NRS pain scores after laparoscopic nephrectomy without complications.
Singh A, Sharma AP, Ganesh V
… +6 more, Gupta R, Sharma G, Naik NB, Sethi P, Kaloria N, Varma P
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40026740
·
Full text
INTRODUCTION: Erector spinae plane block (ESPB) is a relatively newer approach to the paraspinal fascial plane block. The analgesic efficacy of this block is presently being established in percutaneous nephrolithotomy (P...INTRODUCTION: Erector spinae plane block (ESPB) is a relatively newer approach to the paraspinal fascial plane block. The analgesic efficacy of this block is presently being established in percutaneous nephrolithotomy (PCNL). This meta-analysis was designed to assess the effectiveness of ESPB as a perioperative analgesic technique when compared with conventional analgesia (control) in PCNL. MATERIAL AND METHODS: We performed a systematic review and meta-analysis on the use of ESPB for perioperative analgesia in PCNL for renal stone disease. A systematic literature search was conducted in PubMed, Scopus, ProQuest, and EMBASE using the terms ((erector spinae plane block) AND ((Analgesia) OR (visual analogue scale) OR (VAS) OR (opioid*) OR (morphine) OR (tramadol))) AND ((percutaneous nephrolithotomy) OR (PCNL)) with an intention to include all the randomized studies comparing ESPB with the control group. The risk of bias was assessed using RoB2. RESULTS: A total of 187 records were identified and after the exclusions, a total of 10 trials (560 patients, 503 for primary outcome) were included. Pain scores were significantly lower in the ESPB group as compared to the control group except at the 12 postoperative hour. There were significantly better pain scores at 24 h in the ESPB group as compared to the control group (Standardized mean difference (SMD) -0.46, 95% CI (-1.05, 0.13), moderate GRADE evidence). The total opioid consumption was significantly lower in the ESPB group (SMD -1.50, 95% CI (-1.7 to -1.29, moderate GRADE evidence). CONCLUSIONS: ESPB is more effective than conventional analgesia in terms of postoperative opioid consumption after PCNL. Future studies should incorporate better double-blinding techniques, transparent reporting of methods, and sham controls (such as additional dressing post general anesthesia) which were lacking in the current studies.
Kumar SK, Misra S, Behera BK
… +3 more, Singh N, Muduly DK, Srinivasan A
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40026739
·
Full text
BACKGROUND AND AIMS: No studies have compared the effects of ketamine and dexmedetomidine on bowel recovery. We evaluated the effects of intraoperative low-dose ketamine or dexmedetomidine infusion on postoperative bowel...BACKGROUND AND AIMS: No studies have compared the effects of ketamine and dexmedetomidine on bowel recovery. We evaluated the effects of intraoperative low-dose ketamine or dexmedetomidine infusion on postoperative bowel recovery in patients undergoing gastrointestinal (GI) malignancy surgeries. MATERIAL AND METHODS: This placebo-controlled, randomized study was carried out in 84 American Society of Anesthesiologists II patients, aged 18-70 years, of either gender, undergoing elective open GI malignancy surgeries. Patients received intraoperative infusion of ketamine @ 0.1 mg kg h (KET), dexmedetomidine @ 0.25 μg kg h (DEX), or normal saline (placebo). Primary outcome was the time to first flatus and/or stool. Secondary outcomes included time to extubation, total analgesic requirement, postoperative pain scores, time to feeds, duration of intensive care unit (ICU) and hospital stay, and the incidence of adverse events. Continuous data were analyzed by the one-way analysis of variance (ANOVA) or the Kruskal-Wallis test. Categorical data were analyzed by the Chi-square test or the Fisher's exact test. RESULTS: Median time to passage of flatus and/or stool was 3 [interquartile range (IQR) 2-3] days in the KET group, 2 [IQR 2-3] days in the DEX group, and 2 [IQR 2-3] days in the placebo group ( = 0.53 for placebo vs. KET, 0.81 for placebo vs. DEX, and 0.99 for KET vs. DEX). Pain scores and analgesic consumption were significantly less in the intervention groups versus placebo ( < 0.001). No difference was seen in other secondary outcomes. CONCLUSION: Low-dose ketamine or dexmedetomidine did not result in early bowel recovery despite lower pain scores and opioid consumption in patients undergoing open GI malignancy surgeries.
Mittal AK, Patel AK, Dubey J
… +3 more, Shukla S, Bhasin N, Bhardwaj M
J Anaesthesiol Clin Pharmacol
· 2025 · PMID 40026738
·
Full text
BACKGROUND AND AIMS: Optimal endotracheal tube (ETT) placement in patients with short tracheas by the existing techniques is challenging because of the fixed intratracheal ETT length of insertion. However, in the surface...BACKGROUND AND AIMS: Optimal endotracheal tube (ETT) placement in patients with short tracheas by the existing techniques is challenging because of the fixed intratracheal ETT length of insertion. However, in the surface landmark technique (SLT), the individual's tracheal length (distance between mid-thyroid and manubrium-sternum) was estimated and 3 cm was deducted from it to obtain the desired intratracheal ETT length of insertion. Being a new technique, its reliability in providing optimal placement is yet to be evaluated. Hence, to assess the utility and reliability of SLT in achieving optimal placement, this study was planned. MATERIAL AND METHODS: In this prospective study, 406 participants were equally randomized between SLT and intubation guide mark (IGM) groups for ETT placement. In both groups, ETT tip-carina distance (D) was measured to assess optimal placements. The placements were compared by paired -test. The receiver operating characteristic (ROC) curve analysis was used to assess optimal ETT placement between techniques. RESULTS: The mean D in the SLT (3.52 ± 0.68 cm) group was significantly higher than in the IGM (2.23 ± 1.01 cm) group, with < 0.0001. Consequently, optimal placements were significantly higher in the SLT group (190 [95%]) compared to the IGM (121 [60.5%]) group ( < 0.0001). On ROC, at a cut-off value for D of 1.5 cm, the observed area under the curve to assess optimal ETT placements was significantly better in SLT (0.997, 95% confidence interval [CI] 0.997-1.000) compared to IGM (0.968, 95% CI 0.933-0.988), with < 0.0001. CONCLUSION: Based on the measurement of an individual's tracheal length, SLT is a reliable and useful technique to achieve optimal tube placement.